1. ASSESSMENT OF RECRUIT MOTIVATION AND STRENGTH (ARMS)

Introduction

The global war on terrorism dictates a sustained need for personnel to serve in the military. One important and sensible strategy is to remove unnecessary barriers for those who wish to join. Each year, the Army medically delays or disqualifies over 20% of its applicants, resulting in eventual loss of thousands of individuals who wish to serve. Although some of these actions are best for the individual's health and safety and for the military, a sizeable number might be unnecessary.

The military's accession medical standards have historically been a means to screen out applicants who might not be able to meet the physical demands of military service. Some of these standards, such as that for body weight and composition, are used as surrogate measures of the individual's physical fitness. However, it is unclear whether these surrogate measures accurately indicate an individual's fitness for service is unclear.

The purpose of the Assessment of Recruit Motivation and Strength (ARMS) study is to determine whether a simple, direct assessment of an individual's physical fitness and motivation could be used to identify viable applicants who would otherwise be delayed or denied entry under the current standards. This change from a screening out mentality to a screening in approach could add hundreds, if not thousands, of qualified new enlistees each year, which in turn can help reduce recruitment costs.

Three Component Test

The ARMS is a battery of straightforward tests intended to identify qualified recruits, encourage physical training before shipping, and potentially indicate recruit motivation.

Step Test. The step test used in ARMS is a modification of the Harvard step test, which was developed in 1943.¹ Dynamic physical fitness is scored based on the length of time that an individual endures the test to a maximum of 5 minutes and on the individual's recovery heart rate. Widely evaluated in the literature, the Harvard step test is generally considered an accurate indicator of overall physical fitness that provides a low risk, noninvasive, and relatively quick determination of dynamic physical fitness and potentially screens for poorly motivated individuals.

To perform the step test, the recruit steps up to and down from a platform at a constant pace of 120 steps per minute for 5 minutes or until fatigued to the extent that the recruit must stop. Females step up to a 12-inch platform, and males step up to a 16-inch platform. Passing criteria for the step test were set at completing the full 5 minutes at the set pace.

Pushups.Upper body muscular endurance was tested by requiring recruits to complete as many Army-type pushups as possible in 60 seconds. Females and males were required to complete at least 4 and 15 pushups, respectively, to pass.

Incremental Dynamic Lift. Upper body muscular strength was assessed through the incremental dynamic lift. The incremental dynamic lift weight carriage has variable weights, and the selected weight must be raised to a height of 5 feet. The incremental dynamic lift is used by the Air Force for specific occupations, so the equipment is present in all Military Entrance Processing Station (MEPS) sites. The incremental dynamic lift was discontinued from the ARMS assessment in January 2006 to streamline ARMS testing, and some analyses presented include only the step test and the pushups.

Three Phase Study

The ARMS study was approved by the WRAIR Internal Review Board in February 2004. Phase I involved pilot testing and implementation of tests and study procedures at the MEPS. The data collected in this phase were not used for analysis.

Phase II (fully qualified subjects) included implementation at all six study sites: Atlanta, Buffalo, Chicago, Sacramento, San Antonio, and San Diego. The ARMS test was administered to active duty Army applicants, but their performance did not affect whether they could enlist. These applicants were then followed through initial entry training (IET), and their ARMS performance was evaluated as a predictor of risk of attrition.

Phase III over body fat (OBF) subjects provided automatic waivers to those active duty Army applicants who were disqualified for having body fat over the limit but who could meet the ARMS passing criteria. The guard and reserve applicants were later added to Phase III.

The study sample consisted of all Army recruits who passed through any of six selected MEPS during 1 May 2004-31 December 2005 and met weight/body fat standards. Inclusion in the study was irrespective of gender or race for all active duty, guard, and reserve recruits. In addition, only those applicants who were age 18 years or older were included. Applicants had a choice to opt out of testing if they felt incapable of performing the tests. The Physical Activity Readiness Questionnaire was used to check the capability and readiness of applicants to take the test. Applicants were also given an option to consent to use their medical information for follow-up and outcome analysis.

Preliminary Attrition Findings

Analyses of subjects enrolled during Phase II indicated that those who could pass all components of the ARMS test and joined the Army had significantly lower attrition than those who failed ARMS and enlisted. Although limited subject numbers and follow-up time prevented adjustment for potential confounding factors, the results held as follow-up time was extended and applicant numbers increased. The attrition difference between pass and fail groups was more pronounced among male subjects.

The finding of lower attrition among fully qualified subjects who passed ARMS suggested that the test provides a good indication of applicant fitness and motivation. Phase III was therefore implemented to determine whether similar success in terms of lower attrition could be achieved by individuals exceeding the traditional body weight and body fat standards.

Preliminary analysis indicates that attrition among OBF females who passed ARMS was not statistically different from that among fully qualified females. Attrition among males who exceed the body fat standards but pass the ARMS test was slightly increased relative to fully qualified males. Further analyses will include larger numbers of subjects and longer follow-up time, and thus the ability to account for potential confounding factors will improve.

Comparison of injuries among OBF subjects versus the fully qualified counterparts indicated a slightly increased risk among OBF males for injuries of any type. An increase in risk for heat injury, in particular, was noted, although the number of these was small in all groups. Examinations of particular issues in the ARMS study follow.